MEL80 Wavefront Guided

Repair
Night Vision – Starbursts & Haloes

©DZ Reinstein 2006

[email protected]
Night Vision – Starbursts & Haloes

©DZ Reinstein 2006

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Problem - evaluating success in repair eyes

• Clinical Methods
20/20
– Subjective reporting
– Contrast sensitivity change 20/20
• Objective measures
– Topography
– Wavefront - Zernike coefficients
• Most are vectors
• Magnitude analysis confined to one pupil
diameter

©DZ Reinstein 2006

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Z4,0 Analysis confined to one diameter
Plot of AverageDuHeOS
Z(4,0) Over Pupil Size
0.50

0.45
Z(4,0) Coefficient (microns)

0.40 Pre CRSM Enh

0.35 Post CRSM Enh

0.30

0.25

0.20

0.15

0.10

0.05

0.00
3 3.5 4 4.5 5 5.5 6
Pupil Diameter (mm)

©DZ Reinstein 2006

[email protected]
Z4,0 Analysis over the whole pupil
Plot of exampleDuHeOS
Z(4,0) Over Pupil Size
0.50

0.45
Z(4,0) Coefficient (microns)

0.40 Pre CRSM Enh

0.35 Post CRSM Enh

0.30

0.25

0.20

0.15

0.10

0.05

0.00
3 3.5 4 4.5 5 5.5 6
Pupil Diameter (mm)

©DZ Reinstein 2006

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Aim
• To determine the value of analyzing the
AREA under the RAWS plot as a single
metric of success in night vision repair

©DZ Reinstein 2006

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Study Outline
• Perform NVD’s repair eye study
• Match repair cases to post LASIK controls with
no NVD’s
• Determine differences in descriptive power
between
– Single diameter Z4,0 change
– Area under RAWS plot change
• Correlations with Contrast?

©DZ Reinstein 2006

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Repair Eye Population

• 16 eyes from 9 patients

• All complaining of night vision symptoms after
routine LASIK (14 eyes) or PRK (2 eyes)
• Diagnosis confirmed via Wavefront exams
showing increased aberrations
• Adequate residual stromal thickness confirmed
by Artemis VHF Ultrasound

©DZ Reinstein 2006

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Matched Study
• How much positive spherical aberration can a patient
tolerate without suffering from Night Vision Symptoms?
– This seems to vary from individual to individual!

• To develop a control group to the population of repair

eyes, a matched set was found using the following
criteria
– Four to one match: “happy” postop eyes for each repair
eye
• Matched by pre-operative refraction
• Treated using the Aberration Smart Ablation profile on the
MEL80 CRS-Master
• No night vision problems

©DZ Reinstein 2006

[email protected]
6-mm Diameter Z4,0 Analysis
Average Spherical Aberration
Seidel Higher Z(4,0)
Order RMS Before andPrimary
(Magnitude Analysis)
& Repair Eyes
After Treatment

0.90

0.80

0.70

0.60

0.50
µm

0.40

0.30

0.20

0.10

0.00
Average Pre Average Post Average Repair
Sph Ab 0.137 0.384 0.549

©DZ Reinstein 2006

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Repair Eyes: Contrast Sensitivity
Average Contrast
Average Contrast
Sensitivity Before Before
and After & After Treatment
8 ∆
Normalised ratio averages
7
8
7
* 6
5
8
7 Average Pre
3 cpd
0.83
6 cpd 12 cpd 18 cpd
0.80 0.73 0.63

*
6

*
4 6
5 Average Post 1.04 1.02 0.97 0.98
3 } 20/100 5 8
4

*
2 } 20/70 4 7
3
3 6
2 1 } 20/50
\ Paired t-test of log(values)
2 5
1 4 3 cpd 6 cpd 12 cpd 18 cpd
B } 20/40 1
3 t-test 0.0008 0.0014 0.0016 0.0004
A
Pre C 2
Post 1

D ∆ Boxer Wachler BS, Krueger RR. Normalized

contrast sensitivity values.
3 6 12 18 Journal of Refractive Surgery 1998;14:463-466.
Spatial Frequency - (Cycles Per Degree)

©DZ Reinstein 2006

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Repair Eyes: Contrast Sensitivity
Percentage of Eyes With Normal Contrast
Percentage of Eyes
Complicated Within
Cases Normal
Treated Contrast Range
With Wavefront

100%
88%
90% 81% 81%
75%
Percentage of Eyes

80%
70%
60%
50%
38%
40% 31%
30%
19%
20%
10% 6%
0%
3 cpd 6 cpd 12 cpd 18 cpd
Pre [16] 6% 19% 38% 31%
Post [16] 81% 81% 88% 75%

Contrast Level

©DZ Reinstein 2006

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Repair Eyes: Subjective Improvement
Patient Subjective Improvement Rating
Patient Subjective Improvement
10

8
76%
Rating (Out of 10)

6
88%
5

0
GaB MiT PeY HeD
JaH JaBi GaB AnG NaH NaH PeY JaH SaS SaS MiT HeD
uO oO oO uO
eOD OD uOS rOD aOD aOS oOS eOS aOD aOS oOS uOS
D D D D
Px Subjective 10 9 9 9 9 9 9 8.5 8 8 8 8 6 6 2 1

Patient

©DZ Reinstein 2006

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Repair Case Example: Night Vision Disturbances

• 52 yo F
• LASIK Postop
– Low lighting visual complaints
– 6-mm scotopic, -3.50 D
– Hansatome, B&L 217C (6-mm OZ)

©DZ Reinstein 2006

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Repair Case: Night Vision Disturbances

Pre Enhancement

6.00-mm

OSA Z(4,0) = 0.318

©DZ Reinstein 2006
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Repair Case: Night Vision Disturbances

Post Enhancement

6.00-mm

OSA Z(4,0) = 0.141

©DZ Reinstein 2006
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Repair Case: Night Vision Disturbances

Plot of exampleDuHeOS
Z(4,0) Over Pupil Size
0.35

0.30
Z(4,0) Coefficient (microns)

Pre CRSM Enh

0.25
Post CRSM Enh
0.20
Z(4,0) coefficient measured at
0.15
0.25mm intervals
0.10

0.05

0.00
3 3.5 4 4.5 5 5.5 6
-0.05

-0.10
Pupil Diameter (mm)

©DZ Reinstein 2006

[email protected]
Repair Case vs Control: NVD’s

Plot of exampleJaBiOD
Z(4,0) Over Pupil Size
0.35

0.30 Pre Op Control

Z(4,0) Coefficient (microns)

0.25 Post Op Control

0.20 Pre CRSM Enh

Post CRSM Enh

0.15

0.10

0.05

0.00
3 3.5 4 4.5 5 5.5 6
-0.05

-0.10
Pupil Diameter (mm)

©DZ Reinstein 2006

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Repair Case 2 vs Control: NVD’s

Plot of exampleMiToOS
Z(4,0) Over Pupil Size
0.45

0.40 Pre Op Control

Z(4,0) Coefficient (microns)

0.35 Post Op Control

0.30 Pre CRSM Enh

0.25 Post CRSM Enh

0.20

0.15

0.10

0.05

0.00
3 3.5 4 4.5 5 5.5 6
Pupil Diameter (mm)

©DZ Reinstein 2006

[email protected]
All Repair Cases vs Controls: NVD’s

Plot of AverageMiToOS
Z(4,0) Over Pupil Size
0.60
Z(4,0) Coefficient (microns)

Pre Op Control
0.50
Post Op Control

0.40 Pre CRSM Enh

Post CRSM Enh

0.30

0.20

0.10

0.00
3 3.5 4 4.5 5 5.5 6
Pupil Diameter (mm)

©DZ Reinstein 2006

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Spherical Aberration Fixed Diameter Z4,0
Average Spherical Aberration Z(4,0) in 6-mm Diameter
0.90

0.80

0.70
42%
0.60
* 17%
0.50

* *
µm

0.40

0.30

0.20

0.10

0.00
Average Post
Average Pre Average Post Average Repair
CRSM-Enh
Sph Ab 0.137 0.384 0.549 0.451

©DZ Reinstein 2006

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Spherical Aberration RAWS area Z4,0
Average RAWS for each Group
900
800
700
104%
600
500
* 49%
*
µm 2

400
300 *
200
100
0
Average Post
Average Pre Average Post Average Repair
CRSM-Enh
Sph Ab Area 122 276 563 410

Not significantly
different ©DZ Reinstein 2006
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RAWS Correlation With Contrast Sensitivity

3cpd 6cpd
y = 0.0088x + 0.1358 0.60
0.60 y = -0.0179x + 0.1942
R2 = 0.0093
0.50 0.50 R2 = 0.0667

Change in RAWS
Change in RAWS

0.40 0.40
0.30 0.30
0.20 0.20
0.10 0.10
0.00 0.00
-2 -1 0 1 2 3 4 5 -2 -1 0 1 2 3 4 5 6
Change in Contrast Change in Contrast

12 cpd 18 cpd

0.60 y = 0.0008x + 0.1507 0.60

R2 = 0.0001 y = -0.0274x + 0.2042
0.50 0.50
R2 = 0.1291
Change in RAWS

Change in RAWS
0.40 0.40
0.30 0.30
0.20 0.20
0.10 0.10
0.00 0.00
-2 -1 0 1 2 3 4 5 6 -2 -1 0 1 2 3 4 5 6

Change in Contrast Change in Contrast

©DZ Reinstein 2006

[email protected]
Repair Eyes: Subjective Improvement
Patient Subjective Improvement Rating
Patient Subjective Improvement
10

8
76%
Rating (Out of 10)

6
88%
5

0
GaB MiT PeY HeD
JaH JaBi GaB AnG NaH NaH PeY JaH SaS SaS MiT HeD
uO oO oO uO
eOD OD uOS rOD aOD aOS oOS eOS aOD aOS oOS uOS
D D D D
Px Subjective 10 9 9 9 9 9 9 8.5 8 8 8 8 6 6 2 1

Patient

©DZ Reinstein 2006

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Conclusions
• RAWS area is an interesting parameter,
probably more useful than single
diameter Z4,0 analysis
• No correlation with CS changes
• No correlation with subjective
• Needs further thinking

©DZ Reinstein 2006

[email protected]
Thank you